Journal
JOURNAL OF ANXIETY DISORDERS
Volume 61, Issue -, Pages 89-97Publisher
PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/j.janxdis.2018.10.006
Keywords
PTSD; Exposure therapy; Virtual reality; Technology; Dexamethasone
Categories
Funding
- NIH [MH092576]
- Wounded Warrior Project
- Department of Defense Clinical Trial Grant [W81XWH-10-1-1045]
- National Institute of Mental Health [1R01MH094757-01]
- Brain and Behavior Research Foundation (NARSAD) Distinguished Investigator Grant
- McCormick Foundation
- Wounded Warrior Project (WWP)
- Department of Veterans Affairs (VA)
- National Institute of Health (NIH)
- Woodruff Foundation
- Department of Defense (DOD)
- NIMH
- HHMI
- NARSAD
- Burroughs Wellcome Foundation
- Acadia
- Assurex Health, Inc.
- Axsome
- Janssen
- Otsuka
- Pfizer
- Takeda
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Posttraumatic stress disorder (PTSD) is characterized by exaggerated expression of fear responses to danger and safety cues. Translational research suggests that dexamethasone facilitates fear extinction in animal and human fear conditioning models. For this randomized, placebo-controlled trial (N = 27), we aimed to translate these findings to the clinic by using virtual reality exposure (VRE) therapy for OEF/OIF/OND veterans with PTSD to determine whether dexamethasone will increase the efficacy of exposure therapy for VRE relative to placebo. VRE sessions involved imaginal exposure to the most traumatic war memories while viewing a computer-generated view of virtual Iraq or Afghanistan with multisensory stimulus options used to match patient's description of the trauma. VRE was effective in reducing PTSD symptoms but there was no interaction with dexamethasone. Drop-out rate was significantly higher in the dexamethasone group, with 10 of 13 (76.9%) participants in this group discontinuing, compared to only 4 of 14 (28.5%) in the placebo group, chi(2) = 6.31, p = 0.02. Results indicate that the dexamethasone group may have experienced an increase in PTSD symptoms, particularly re-experiencing, at session 2 following first drug administration. Contrary to study hypotheses, dexamethasone did not enhance exposure therapy outcomes and was associated with increased drop-out. This demonstrates potential pitfalls in translating neuroscience models to the clinic; future research carefully examining glucocorticoid mechanisms involved in therapy augmentation is warranted.
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